megan mogan, ms, ccc-slp chris russell, ms. ed, tvi student-centered aac design and intervention:...

Megan Mogan, MS, CCC-SLPChris Russell, MS. Ed, TVI

Student-Centered AAC Design and Intervention: Practical, Collaborative

Approaches for Learners with Visual

Impairments and Additional Disabilities

Part 2: Implementation1

1. Review of Part 1 (AAC Design)2. Philosophical Approaches3. Presentation and Interaction

Strategies 4. Functional AAC Implementation 5. Ongoing Assessment 6. Resources 7. Questions

Part 2 Overview: AAC Implementation

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Review of Part 1: AAC Design

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• Symbol and System Adaptations• Vocabulary Selection

• Multiple Systems• Collaborative Approaches

Review of Part 1: Design

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●Collaborative Teaming●Communication Bill of

Rights

Philosophical Approaches for Successful Implementation

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Collaborative Teaming

Whose role is it to:

● Plan communication routines● Facilitate access to AAC

system● Teach and model system use● Monitor progress● Update systems

RESOURCE: Facilitating Collaboration 6

Training● Pre-service / in-service● Staff training● Peer training

Shared Approach● Roles and responsibilities

○ Role release; classroom staff● Strategies

Collaborative Teaming

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http://www.asha.org/NJC/bill_of_rights.htm

Communication Bill of Rights

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A VI learner has access to understandable communication forms surrounding the topic of “Juicing.” He also has access to his partner and her interaction with those communication forms.

Additional communication rights

●Accessible Communication Forms and Topics

○Nonverbal forms (pointing)

○Visual systems of Communication (pictures, print)

Communication Bill of Rights

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A student with visual impairment and cerebral palsy has access to his partners’ locations at a table (and their communication turns) using a tactile table map with each student’s adapted name symbol.

Additional communication rights

●Accessible Social Interactions

○locating partners○Identifying turns in an

exchange○Access to partners

attention or intent (facial expressions, eye gaze)

Communication Bill of Rights

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Additional communication rights

●Accessible auditory or tactile representations (vocabulary/messages)

●Accessible, direct input when learning alternative systems or new communication skills

A VI learner indicates he is finished carrying out a step of his sensory routine by moving a label to a “finished” container. He received hand-under-hand modeling to learn how to access the steps in this routine using alternative forms of communication.

Communication Bill of Rights

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●Where is an aided system kept?○Consistent, within reach○Within visual field and distance○Consider routes and obstacles○Accessing the system is an

interaction●Is placement dependent on

system?○Device? Symbols? Board?

Access: Placement of System

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● Choosing meaningful placement○ Student’s personal

space(s)○ Activity-based/location-

based● Labels: tactile, visual● Aprons, pockets, pouches

○ eg to make more portable

● Using a special shelf or box to hold the object symbols (Blaha & Moss, 1997)

● Teaching routes to access placement

Access: Adapting Placement

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Presentation and Interaction Strategies for Implementation of Student-Centered AAC

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“Which AAC technique is ‘best’ for a given individual depends on: the learning/developmental priorities for the person; the person’s existing skills and abilities; the person’s and family’s preferences; the person’s current and future communication needs; and the environments in which and the people with whom the person is likely to interact.” - Mirenda, 2005

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are:

● Consistent

● Predictable

● Motivating / Child-centered

…in routines that allow for:

● Anticipation

● Practice

● Success

● Fun and social exchanges!

Environments that encourage communication

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Responsive...

Observant

Available• Proximity

(visual, tactile)o constant

contact, touch cues

Characteristics of Communication Partners

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(Bruce & Vargas, 2007; Brady & Bashinki, 2008)

Responsiveness is the ability to… ● Recognize● Interpret● Respond Appropriately…to a partner’s communication initiations and responses

Responsive communication partners

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(Bruce, 2003; Miles & Riggio, 1999; Miles, 2003)

Means using a variety of strategies including:● shared forms of communication● non-intrusive hand use and

interaction● scaffolding communication and

prompting

Responding “Appropriately”

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“In addition to technology, ...early communication programs may be maximally effective when participants are taught to combine technology with unaided communication responses.”

- Brady & Bashinski, 2008

Remember to use MULTIPLE MODES!

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•(Bruce, 2005; van Dijk, 1999; Miles & Riggio, 1999; Alsop, 2010)

TYPICAL SENSORY ACCESS

CONGENITALLY DEAF-BLIND

Direct Instruction

Secondary Learning

Incidental Learning

Children with VI/DB:● Lack access to incidental learning● Require facilitated experiences to support

development

Direct instruction

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Building correspondence between AAC forms and the messages

they represent within interactions is a balancing act.

What are the student’s hands on?• A device? • The activity or topic of

conversation?• A partner?

• Direct instruction of AAC• Constant contact and multiple

modes• Direct facilitated tactile access to

topics

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(Miles, 2003)

● Is non-controlling.

● Shared experiences

● Facilitating but not obstructing

● Encouraging exploration

Hand Use: Hand-under-hand

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● Facilitating access to topics of conversation (objects, activities, processes and social experiences)

● Exploring and accessing communication modes

● Modeling and teaching use of a system● Engaging in and sustaining a conversation

or interaction○ Touch cues and tactile confirmation ○ constant contact

Hand Use and AAC

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- Belote, 2005

“One or two minutes sounds like a relatively short period of time, but when you are waiting for a child to act on a request, it can seem like an eternity.”

Processing (“wait”) time

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How much time should I wait?

o Motor responseo Cognitive

processing

What are you waiting for?●Student to initiate/send a

message●Student to receive a message

and respond

Processing (“wait”) time and AAC

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(Engleman, Griffin, & Wheeler, 1998; Johnson & Parker, 2013; Miles & Riggio, 1999)

● Pace of interaction○ Wait time different for different AAC

modes?○ Familiarity with routine and activity

Prompt level and scaffolding■wait time will change (fatigue,

stress, arousal level)

Processing (“wait”) time

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●Supplementing communication routines by modeling topics of reference

●Exposure to how a device can be used

●Navigating the device●Modeling secondary/multiple modes●Modeling social routines and

responses

Modeling can be tactile, visual, auditory,

or a combination

Modeling and AAC

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Reliant upon responsive communication partner

Partner assisted scanning on an iPad with a yellow cardboard square cutout/guide

(Burkhart & Porter, 2012; Hanser, 2007)

● Facilitate use of current receptive vocabulary

● Teach new symbols/words● Develop visual skills● Pair with other modes● Expand: levels of selection● Can be used across

multiple forms

Pointing, showing, speaking messages a student will select

Partner-Assisted Scanning

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A teacher uses first pointing/gesturing, then a manual sign (“bathroom”) to prompt a student to locate the next symbol on his calendar.

●Identify appropriate prompt levels○ support success and

increased independence/interdependence

○ Start where the student is, not under or too far over! (ZPD)

●Guided participation○ Allows for shared

experience, conversation, direct instruction

Prompt fading and scaffolding

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Least Intrusive

Most Intrusive

● Wait for response● Gesture, pointing (finger,

flashlight, auditory cue to localize/tapping, hand-under-hand pointing)

● Verbal or tactile (signed) prompt, touch cue○ Note levels of VP

● Visual modeling, hand-under-hand modeling

● Hand-under-hand instruction● Hand-over-hand instruction /

coactive shaping

Prompt Hierarchy

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Standard Routine / Step

Individual Steps Level of prompt, additional accommodations

Morning Circle: 1) Say good morning to peers

2)....3)....

1)A. Recognize that it is

my turn to say ”Good Morning”

B. Locate peer(s) individually

C. Locate 2-cell VOCA device

D. Locate tactile/visually adapted label for “Good Morning”

E. Press switch to activate VOCA

Scaffolded: Wait time - 5-10 seconds;Light touch cue on forearm to indicate turn, paired with light VP to identify; gestural prompt toward peer(s) and light VP; VP “which one?” point to each label on VOCA; more descriptive VP paired with hand-under-hand for “this side says “good morning”/describe distinct tactile component; hand-under-hand tactile modeling press switch

Task Analysis: Planning Prompt Levels

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(Roman, 2007)

● Allow time for visual processing / latency!

● Use movement to gain attention● Color - design and presentation ● Consider complexity of array and

environment● Present in accessible visual fields● Use light to draw attention, decrease

latency● Consider the distance of presentation● Consider access via visually guided

reach● Consider the impact of novelty

Presentation and CVI

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Functional Implementation of

Student-Centered AAC Across Routines

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is for the student to increase:

●Levels of communication●Functions of communication●Rate of communication●Number of different routines●Number of communication

partners

The goal of communication intervention

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Students with Complex Communication Needs:

● Often have a respondent role (few initiations) compared to partners who speak (Culp, 1982; Harris, 1982;

Light, Collier, and Parnes, 1985)

● Have unequal turn-taking patterns, with the natural speaker taking the majority of turns (Farrier, Yorkston, Marriner, &

Buekelman, 1985; Light, et al., 1985)

Individualized Approaches

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For students in self-contained classrooms…

Instructional time is frequently lost to other activities such as repairing technology, moving in and between classrooms, toileting, eating, and attending therapies.

(Koppenhaver & Yoder, 1993)

Individualized Approaches

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A student in a plastic molded chair reaching out to touch the bracelet/topic of a student seated in a wheelchair

• Use collections as a concrete way to start a topic with peers or unfamiliar partners (Musselwhite, 2006)

• Pair the objects with pre-loaded messages on single-message or sequencing device

Individualized Approaches

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Collection Scripts (Musselwhite, 2006)

Big Mack AAC device

Hey there.Did you see my bracelet?!It makes a cool sound when I shake my arm.Do you want to feel it?Talk to you later!

Step By Step Sequencing Device

“Hey check out my bracelet!” [Pair message with the student extending their bracelet arm toward a partner]

Individualized Approaches

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Individualized ApproachesSharing Experiences using AAC

Describe student’s favorite parts about an activity or experience using

● flip book with symbols and accompanying print messages

● a sequencing device with a single “topic” symbol

● Pictello app or Sounding Board app on iPad

Pictello™ app from Assistiveware®

SoundingBoard™ app by AbleNet®

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Individualized ApproachesShared ReadingUse a Single Message System to

● Repeat a line of a preferred story

● Make a silly, recurring sound effect

● Request the reader makes a motivating action or change in reading style (e.g. “Can you read it with a scary voice?”)

Invite the President of the United States to read aloud with your AAC user!

Tip: Invite “guest readers” from other classrooms (Same-age peers), office or custodial staff, family members, etc. This builds a student’s interactions with different partners. 41

Sequence a series of calls and/or responses for a preferred song or chant

● Frere Jaques tune

● Going on a Bear Hunt

● Down by the Bay

● “Oldies” songs for older students

Individualized Approaches

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Embed vocabulary and concepts within motivating, repetitive interactions with classmates

● Use attribute vocabulary (e.g. “hot, little, bad, boring, etc.”) to lead a game of Guess the Opposite

● Use phrases of rejection (e.g. “no way, nope, I don’t think so…. etc.”) to respond to 20 Silly Questions from peers

Individualized Approaches

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● Use sequencing vocabulary (e.g. “And then…. Next….Followed by…” as student leads others in a daily calendar read-aloud

● Use action vocabulary to direct classmates in performing or singing routine songs (e.g. “Hum it.” “Snap the song” “Whisper”

“Next….PE.” “Then....Cooking!”

Embed vocabulary and concepts within motivating, repetitive interactions with classmates

Individualized Approaches

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Splash!● Sound Effects

● Babbling (Burkhart)

● Use a sequencer to load multiple messages representing the same language function “Cool,” “Love it!” “No way” “Awesome…”

● Build in time for access to exploration

Play with voice output

Individualized Approaches

Ongoing assessment is not the same as starting over:

“It is a matter of keeping decision-guiding information accurate, up to date, and clearly inclusive of the shared knowledge of all involved !” -Joy Zabala

● Communication Matrix: expressive, level toward symbolism

● Rate assessment (rate of Intentional Communication Acts / minute/activity)

Ongoing Assessment: AAC System

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Classroom Observation Instrument (Taylor, Stremel, & Steele, 2006)

https://nationaldb.org/library/page/534

Self-Assessment: Implementation

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• Collaborative roles• Communication Rights• Characteristics of effective

communication partners and environments

• Responsive strategies for modeling, presenting, scaffolding AAC use

• Ideas for implementing across routines and environments

• Assessment of progress and self/team

Takeaways

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Resources

● (ASHA) Communication Bill of Rights: http://www.asha.org/uploadedFiles/NJC-Communication-Bill-Rights.pdf

● Communication Matrix: http://communicationmatrix.org/

● Literacy for Children with Combined Vision and Hearing Loss: http://literacy.nationaldb.org/

● National Center on Deaf-Blindness: http://www.nationaldb.org

● Object Cues, Tangible Symbols, Calendar Boxes: ● Blaha & Moss, 1997: http://

www.tsbvi.edu/seehear/archive/Let%20Me%20Check%20My%20Calendar.htm; ● Belote, 2005: http://www.sfsu.edu/~cadbs/Spring05.pdf#page=5

● Paths to Literacy: http://www.pathstoliteracy.org/

● Perkins: http://www.perkinselearning.org/

● PrAACtical AAC: http://praacticalaac.org/

● Simplified Technology (Linda Burkhart): http://www.lburkhart.com/

● TSBVI: http://www.tsbvi.edu

● Table of Collaborative Roles (attached)51

Questions?

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ReferencesAmerican Speech-Language-Hearing Association Augmentative and Alternative

Communication (AAC). Retrieved 2015 from http://www.asha.org/public/speech/disorders/AAC/

ASHA (1992). Guidelines for meeting the communication needs of persons with severe disabilities. From the National Joint Committee for the Communicative Needs of Persons with Severe DisabilitiesAsha, 34 (Suppl. 7), 2–3 Retrieved July 2015 from http://www.asha.org

Belote, M. (2005). Getting started with object communication. reSources: California Deaf-Blind Services, 11(5), 5-7, Retrieved 2015 from http://nationaldb.org

Beukelman, David R., and Pat Mirenda. Augmentative & Alternative Communication: Supporting Children & Adults with Complex Communication Needs. Baltimore: Paul H. Brookes Pub., 2005. Print.

Blaha, R., & Moss, K. (1997). Let me check my calendar. SEE/HEAR. Retrieved 2015 from http://www.tsbvi.edu/seehear/archive/Let%20Me%20Check%20My%20Calendar.htm

Brady & Bashinski (2008). Increasing communication in children with concurrent vision and hearing loss. Research & Practice for Persons with Severe Disabilities, 33 (1-2), 59-70.

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Bruce, S.M. (2003). The Importance of Shared Communication Forms, Journal of Visual Impairment and Blindness, 97 (2), p. 106-9.

Burkhart, L. (1994). Organizing vocabulary on dynamic display devices: Practical ideas and strategies. Paper presented at the Sixth Biennial Conference of ISAAC, Maastricht, The Netherlands.

Burkhart, L. Key Concepts for Using Augmentative Communication with Children Who Have Complex Communication Needs. Retrieved 2015 from: http://www.lburkhart.com/hand_AAC_OSU_6_08.pdf

Burkhart, L., & Porter, G. (2006). Partner-assisted communication strategies for children who face multiple challenges (Pre-conference instructional course), ISAAC 2006, Dusseldorf. Retrieved 2015 from http://www.lburkhart.com

Burkhart, L. (2012). “Light tech” communication part 1: Partner-assisted scanning. (Presentation). Retrieved 2015 from http://www.lburkhart.com

Burkhart, L. (2014). Practical strategies for implementing aided language stimulation (Presentation). Retrieved 2015 from http://www.lburkhart.com

Downing, J., & Chen, D. (2006). Using tactile strategies with students who are blind and have severe disabilities. TEACHING Exceptional Children, 36(2), pp. 56-60.

Engleman, M.D., Griffin, H.C., & Wheeler, L. (1998). Deaf-blindness and communication: Practical knowledge and strategies. Journal of Visual Impairment and BlindnessI, 92(11), pp. 783-98

Hanser, G. (2007). Promoting communication on the fly for students with significant disabilities, including deaf-blindness: Top 10 tips for partner assisted scanning. Retrieved 2010 from http://www.med.unc.edu/ahs/clds

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Hagood, Linda. Communication: A Guide for Teaching Students with Visual and Multiple Impairments. Austin, TX: Texas School for the Blind and Visually Impaired, 1997. Print.

Johnson, N., & Parker, A. T. (2013). Effects of Wait Time When Communicating with Children Who Have Sensory and Additional Disabilities. Journal of Visual Impairment & Blindness, 107(5), 363.

Kreuzer, D.T. (2007). Considerations for the use of visual displays and materials for students with visual impairments, severe speech and physical impairments. Presented September 27, 2007 at AAC by the Bay. Obtained 2015 by author.

Lueck, A., & Heinz, T. (2004). Interventions for young children with visual impairments and students with visual and multiple disabilities. In A.H. Lueck (Ed.), Functional Vision: A Practitioner’s Guide to Evaluation and Intervention. New York: AFB Press.

Miles, B. (2003). Talking the language of the hands to the hands. DB-Link. Retrieved 2015 from http://www.nationaldb.org/documents/products/hands.pdfMiles, B., & Riggio, M. (1999). Remarkable conversations: A guide to developing meaningful communication with children and young adults who are deafblind. Perkins School for the Blind.

Musselwhite, Caroline and St. Louis, Karen Waterman. Communication Programming for Persons with Severe Handicaps: Vocal and Augmentative Strategies (2nd. Edition). Austin, TX: Pro-Ed, 1988. Print.

Musselwhite, Caroline. AAC and Topic Setting: Getting the Most Bang for your Buck. Retrieved 2015 from http://aacintervention.com

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Parker, A. T., Grimmett, E. S., & Summers, S. (2008). Evidence-based communication practices for children with visual impairments and additional disabilities: An examination of single-subject design studies. Journal of Visual Impairment & Blindness, 102(9), 540-552.

Roman-Lantzy, C. (2007). Cortical visual impairment: An approach to assessment and intervention. New York: AFB Press.

Rowland, C. (2011). Using the communication matrix to assess expressive skills in early communicators. Communication Disorders Quarterly, 1525740110394651.

Rowland, C. & Fried-Oken, M. (2010). Communication Matrix: A clinical and Research Assessment Tool Targeting Children with Severe Communication Disorders. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 3, 319-329.

Rowland, C., & Schweigert, P. (2000). Tangible symbols, tangible outcomes. Augmentative and Alternative Communication, 16(2), 61-78.

Roche, L., Sigafoos, J., Lancioni, G. E., O'Reilly, M. F., Green, V. A., Sutherland, D., & Edrisinha, C. D. (2014). Tangible symbols as an AAC option for individuals with developmental disabilities: A systematic review of intervention studies. Augmentative and Alternative Communication, 30(1), 28-39.

Taylor, Stremel, & Steele. (2006). Classroom Observation Instrument for Educational Environments Serving Students with Deaf-Blindness. Monmouth, OR: NTAC.

Zabala, J. Using the SETT Framework to Level the Learning Field for Students with Disabilities. (2005) Retrieved 2015 from http://www.joyzabala.com/uploads/Zabala_SETT_Leveling_the_Learning_Field.pdf

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